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Medical Coding News Archives

Brush-up on Billing Ambulance Services

March 1, 2012:

Trudy Whitehead, Clinical/Technical Editor

The erroneous claims a recovery audit contractor recently discovered suggest that ambulance service providers and hospitals could use a refresher on billing guidelines.

In its Medicare Quarterly Provider Compliance Newsletter of January 2012, the Centers for Medicare and Medicaid Services noted that an auditor had found more than 1,000 erroneous claims for ambulance services.

Ambulance services provided during a Medicare beneficiary’s inpatient stay—for instance, to transport the patient to another facility for services the hospital does not provide—are billed to the hospital where the beneficiary is an inpatient, not to Medicare Part B. Such services are considered part of the inpatient treatment and are therefore covered by the Medicare severity diagnosis-related group (MS-DRG) payment set for the patient’s condition. The MS-DRG payment covers all items and nonphysician services inpatients receive, whether the items and services are provided by the hospital directly or by another entity under an agreement with the hospital.

Hospitals are required to provide ambulance services either directly or under arrangement with an ambulance provider.

This guideline does not apply to ambulance services on the day of admission or discharge, or any dates of service reported with occurrence span code 74 (Noncovered level of care), plus one day, during a leave of absence from the inpatient facility. For such services, the provider of ambulance services bills Medicare Part B directly.